S39 examination showed delayed gastric emptying with a lesser curve gastric ulcer. Acid secretory studies showed no response to insulin, indicating a complete vagotomy. At reoperation, eight months after the first operation, a lesser curve gastric ulcer was present but no duodenal ulcer. He is now well after antrectomy.Case 3.-An insulin test was negative three months after vagotomy in a man aged 37. After one year he developed epigastric pain and vomiting and barium meal examination showed a lesser curve gastric ulcer with normal gastric emptying. The ulcer was confirmed by gastroscopy. Conservative treatment of the ulcer was undertaken and further gastroscopy showed that the ulcer was healing. Fourteen months after the operation and two months after the development of a gastric ulcer a barium meal examination showed an apparently normal stomach which still emptied normally. He was then symptom-free. DiscussionThe idea of treating patients with duodenal ulceration by vagotomy without a drainage operation is attractive and has been the goal of many surgeons. Dragstedt and Owens (1943) Jrournal, 1972, 1, 539-542 Summary Ventolin (salbutamol) and Medihaler-Duo (isoprenaline/ phenylephrine combination) standard pressurized inhalers were used to administer doses of two or six "puffs" to 16 patients with known reversible airways obstruction.The doses were administered in random order over two days. Both the Ventolin and Medihaler-Duo inhalers substantially increased FEV1, but in the doses used salbutamol was more effective than isoprenaline/phenylephrine (P < 001). There was no significant difference between two and six puffs of salbutamol, though there seemed to be an advantage of six puffs of isoprenaline/ phenylephrine over two puffs (P < 0 05). Adrenaline (1/1,000) 0 5 ml and atropine 0 6 mg produced similar increases in FEV1 to those produced by salbutamol.County Hospital, Hereford R.

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Background-There is evidence that patients with chronic obstructive airways disease and asthma who take inhaled steroids have a low bone density. As most of a drug given from a metered dose inhaler is actually swallowed, the possibility that swallowed beclomethasone dipropionate acts topically in the gut to impair calcium absorption was investigated. Such